Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

Dina Goodman, Mary E. Crocker, Farhan Pervaiz, Eric D. McCollum, Kyle Steenland, Suzanne M. Simkovich, Catherine H. Miele, Laura L. Hammitt, Phabiola Herrera, Heather J. Zar, Harry Campbell, Claudio F. Lanata, John P. McCracken, Lisa M. Thompson, Ghislaine Rosa, Miles A. Kirby, Sarada Garg, Gurusamy Thangavel, Vijayalakshmi Thanasekaraan, Kalpana BalakrishnanCarina King, Thomas Clasen, William Checkley, Abidan Nambajimana, Ajay Pillarisetti, Amit Verma, Amy Lovvorn, Anaité Diaz, Aris Papageorghiou, Ashley Toenjes, Ashlinn Quinn, Azhar Nizam, Barry Ryan, Bonnie Young, Dana Barr, Eduardo Canuz, Elisa Puzzolo, Eric McCollum, Erick Mollinedo, Fiona Majorin, Florien Ndagijimana, Howard Chang, Irma Fuentes, J. Jaime Miranda, J. D. Ntivuguruzwa, Jean Uwizeyimana, Jennifer Peel, Jeremy Sarnat, Jiawen Liao, John McCracken, Joshua Rosenthal, Juan Espinoza, J. M. Campbell, Kendra Williams, Kirk Smith, Krishnendu Mukhopadhyay, Lance Waller, Lawrence Moulton, Lindsay Jaacks, Lindsay Underhill, Lisa de la Fuentes, Lisa Elon, Lisa Thompson, Luke Naeher, Maggie Clark, Margaret Laws, Marilú Chiang, Marjorie Howard, Mary Crocker, Michael Johnson, Miles Kirby, Naveen Puttaswamy, Oscar De Leon, Rachel Craik, Rachel Merrick, Ricardo Piedrahita, Sankar Sambandam, Sarah Rajkumar, Savannah Gupton, Shakir Hossen, Sheela Sinharoy, Shirin Jabbarzadeh, Stella Hartinger, Steven Harvey, Suzanne Simkovich, Usha Ramakrishnan, Vanessa Burrowes, Victor Davila-Roman, Vigneswari Aravindalochanan, Yunyun Chen, Zoe Sakas

Research output: Contribution to journalReview article

Abstract

Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.

Original languageEnglish (US)
Pages (from-to)1068-1083
Number of pages16
JournalThe Lancet Respiratory Medicine
Volume7
Issue number12
DOIs
StatePublished - Dec 2019

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Goodman, D., Crocker, M. E., Pervaiz, F., McCollum, E. D., Steenland, K., Simkovich, S. M., Miele, C. H., Hammitt, L. L., Herrera, P., Zar, H. J., Campbell, H., Lanata, C. F., McCracken, J. P., Thompson, L. M., Rosa, G., Kirby, M. A., Garg, S., Thangavel, G., Thanasekaraan, V., ... Sakas, Z. (2019). Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group. The Lancet Respiratory Medicine, 7(12), 1068-1083. https://doi.org/10.1016/S2213-2600(19)30249-8